Identity/Concept of Long Term Care
Values
whether there are sets of values that are shaping political, organisational and individual choices in LTC
COUNTRY / LOCATION: United Kingdom
Keywords: long term care funding, sustainability, involvement, shared values, shared decision making
Keywords: long term care funding, sustainability, involvement, shared values, shared decision making
The ‘Big Care Debate’ – public engagement in LTC funding
Summary
With an ageing population and rapidly escalating health and social care costs, the previous New Labour government (1997-2010) developed a national ‘Big Care Debate’. When starting to consult around future options for funding long term care for older people (and people of working age), the government quickly realised that very few people understood the current system and so could not meaningfully comment on future options. The ‘Big Care Debate’ was therefore a national initiative to raise awareness of the current long term care system, seek views on current provision and involve current service users, key stakeholders and the wider public in debates about future funding options.
What is the main benefit for people in need of care and/or carers?
Current and future service users’ and their families’ views were sought on funding options for long term care services. The big care debate had the added benefit of raising awareness of the current system amongst these stakeholders.
What is the main message for practice and/or policy in relation to this sub-theme?
Having identified the need to explore fundamental LTC reform at a national level, this public consultation was helpful for raising awareness, encouraging debate and building consensus about future reforms.
Why was this example implemented?
With an ageing population and rising public expectations of health and social care services, the current system in England is widely perceived as financially unsustainable. Following high profile reviews in 1999 and 2006, a 2009 Green Paper set out a series of options for funding institutional forms of care for older people (and those of working age) – all of which involved a much greater “partnership” between the state and individual. Some of the potential solutions proposed also involved a loss of social security entitlements in return for slightly more generous long term care funding and/or a potential role for either voluntary or compulsory insurance. According to official estimates (see HM Government documents at the end of this case study for further details):
- In the next 20 years, the number of people aged over 85 in England will double and the number over 100 will quadruple.
- In 20 years time, there could be a £6 (€6.8) billion funding gap.
- If the current system remains unchanged, then the cost of disability benefits could rise by almost 50 per cent in the next 20 years, while the cost of long term care could rise by 17 per cent by 2027/28.
Taken together, these statistics have raised the profile of the funding of services for older people – and provided the motivation for significant national policy development and the ‘Big Care Debate’ consultation.
Description
The Big Care Debate consultation (led by the English Department of Health) aimed to gather public opinion around how a care and support system should be organised. The consultation gathered opinion and preference on different models of funding, as well as looking at what aspects of social care the public valued. The consultation was open to the entire population; however various target groups were identified to ensure participation from a broad range of groups, including: ethnic minority groups, carers, community/voluntary groups, council tenants, councillors / Members of Parliament, disabled people, faith groups, lesbian and gay people, potential and non-users of services, older people, people with learning difficulties, service users and staff.
This was the largest UK public consultation on social care services to date. It set out to reach people all over the country. In order to achieve this, a touring a programme of regional public and stakeholder events was carried out, consulting people on the reform options set out in the (2009) Green Paper ‘Shaping the Future of Care Together’. There were 37 stakeholder events (for key health and social care partners and interested parties) and 80 public roadshows (held in shopping centres, county shows etc). Views were also sought via various web-based platforms, GP practices, charities and other stakeholder organisations. Methods of joining the debate included: through a central Department of Health ‘Care and Support’ website, via Facebook/Twitter or by filling in the Big Care Questionnaire or leaflets placed in General Practice surgeries and other public places.
What are/were the effects?
The debate was used to raise awareness of long term care funding and to seek views on specific options for future reform. This contributed directly to proposals put forward in a 2010 White Paper on future funding (which tried to summarise public opinion and put forward policy proposals in response). In practice, the White Paper was not implemented due to a change in government at the 2010 general election). However, the new Coalition government has set up a one-year Commission to explore future funding options, and policy commentators expect the key themes from the Big Care Debate to be influential here. A three-year review of all government spending also saw additional money allocated to fund health and social care (despite massive cuts in almost all other departments/sectors) – and this might be at least in part because of the Big Care Debate (and other forms of evidence) having successfully made the case for future reform and improved funding for adult social care (although clearly it is impossible to tell in practice).
What are the strengths and limitations?
Over 28,000 individuals and organisations responded to the debate. While this is clearly a small number overall, social care in the UK is poorly understood and this is likely to be a much higher response rate than previous consultations on such issues. The vast majority of respondents were individual members of the public and a small proportion of responses came from national or local stakeholder organisations. Although detailed policy proposals were shelved when a new government was elected in 2010, the funding of long term care is a complex long term issue and such a national debate was arguably needed to help raise awareness, stimulate debate, explore potential trade-offs and seek to build consensus about next steps. Overall, we have no information on costs and no independent evaluation of the impact of the process. It is also difficult to judge the motives of the different groups designing, implementing and taking part in this process, or the extent to which policy makers were genuinely interested in hearing answers to the questions they asked and to involving seldom heard groups. However, this was the largest and most significant initiative of its kind to date in England, and may serve as an interesting – if ambiguous – example for other countries.
Credits
Author: Jon GlasbyReviewer 1: Michel Naiditch
Reviewer 2: Laura Cordero
Verified by:
External Links and References
Peer review:
- (2009) England’s Big Care Debate (editorial) The Lancet, Volume 374, Issue 9686: 265.
Policy documents:
- HM Government (2009) Shaping the future of care together (Green Paper). London: TSO.
- HM Government (2010) Building the National Care Service (White Paper). London: TSO.
Web-based documents:
- Department of Health (2010) Social Care Bulletin White Paper Special.
